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Premature Rupture of Membranes

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(PROM)

Definition

Premature rupture of membranes (PROM) is the breaking of the amniotic sac before labor begins. The sac contains amniotic fluid and the developing baby. With PROM, the amniotic fluid inside the sac leaks or gushes out of the vagina. This is also known as your water breaking.
Fetus with Amniotic Sac
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PROM occurs during the third trimester after 37 weeks of gestation. A related condition called preterm premature rupture of membranes (PPROM) occurs before 37 weeks of gestation.
PROM increases the risks of certain pregnancy complications, including:
Call your doctor right away if you suspect that your water has broken.

Causes

The causes of PROM are not clearly understood. Some of the possible causes are:
  • Early dilation of the cervix (may be due to the weight of baby and placenta, or changes in the cervix itself)
  • Infections of the vagina, uterus, or membranes surrounding the fetus

Risk Factors

The following factors may increase your chance of PROM:
  • PROM in earlier pregnancies
  • Infection in the amniotic sac
  • Other infections in mother (eg, chlamydia )
  • Bleeding during the second and third trimester
  • Amniocentesis
  • Certain procedures used to treat abnormal conditions of the cervix (eg, cervical conization )
  • Lung disease during pregnancy
  • Connective tissue disease
  • Nutritional deficits
  • Low body mass index
  • Smoking during pregnancy

Symptoms

The main symptom of PROM is fluid leaking from the vagina. You may experience a sudden gush of fluid or a slow, constant trickle. It can be difficult to distinguish between a slow amniotic trickle or urine. Your doctor can do simple tests to determine this.
PROM also increases the risk of infection. Symptoms include a fever above 100.4ºF (38ºC). If you have any of these symptoms, call your doctor right away.

Diagnosis

If a large amount of fluid is leaking from the vagina, diagnosing PROM can be straightforward. To confirm the diagnosis, the doctor may do the following tests:
  • Visual exam—the doctor may be able to see a trickle of fluid through the cervix, or a pool of fluid collected behind the cervix
  • A nitrazine paper test—the doctor puts a small amount of fluid on a piece of paper to see if it is amniotic fluid
  • Look at the fluid under a microscope to see if it is amniotic fluid
The doctor will also check you for fever and other signs of infection. He will monitor your baby for any signs of distress.

Treatment

Treatment of PROM depends on when it occurs in the pregnancy. If it is close to your due date, you and your baby will be watched closely. For example, your baby’s heart rate will be monitored.
Labor usually begins within 24 hours after PROM. If labor does not begin soon after your water breaks, the risk of infection increases. In many cases, labor will be induced by giving you medicines. Antibiotics may also be given.

Prevention

Researchers are investigating ways to prevent PROM. Taking antibiotics during the second and third trimester may reduce your risk. Taking vitamin C may also lower your chance of developing PROM. You can also take steps for a healthier pregnancy, like quitting smoking .

RESOURCES

American Pregnancy Association http://www.americanpregnancy.org/

National Institute of Child Health and Development http://www.nichd.nih.gov/

CANADIAN RESOURCES

About Kids Health http://www.aboutkidshealth.ca/

The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org/index%5Fe.asp/

References

Cunningham FG, et al. Williams Obstetrics . 22nd ed. New York, NY: McGraw-Hill Medical Publishing Division; 2005.

DynaMed editors. Premature rupture of membranes at term (term PROM). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 2010. Accessed June 1, 2010.

Eisenberg A, Murkoff HE, Hathaway SE. What to Expect When You’re Expecting . New York: Workman Publishing; 2002.

Ferris DG. Management of bacterial vaginosis during pregnancy. Am Fam Physician . 1998;57(6).

Jeffcoat MK, et al. Periodontal disease and premature birth: results of a pilot intervention. J Periodontology . 2003;74(8);1214.

Kohnle D. Placental abruption. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated May 2008. Accessed December 1, 2008.

Pregnancy Info.net. Premature rupture of membranes: causes, risks, and treatment. Pregnancy Info.net website. Available at: http://www.pregnancy-info.net/prom.html . Accessed June 1, 2010.

Premature rupture of membranes. CHC Wausau Hospital Medical Library and Patient Education website. Available at: http://www.chclibrary.org/micromed/00061770.html . Accessed August 31, 2005.

Premature Rupture of Membranes, Practice Bulletin No. 80, April 2007, The American College of Obstetricians and Gynecologists.

Revision Information

  • Reviewer: Andrea Chisholm
  • Review Date: 10/2012 -
  • Update Date: 10/31/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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